As recommended by the World Health Organization (WHO), the ideal doctor-to-population ratio is 1 per 1,000 persons. But in reality, Africa can only boast of 1 per 10,000 persons, and the shortage worsens by the day. By 2035, the insufficiency is expected to reach 4.3 million physicians. Despite the huge gap, the continent has been suffering an increasing medical brain drain as its trained health workers migrate in droves to developed countries, including the U.S., U.K. and Canada.
Africa bears 23% of the global disease burden. But in contrast, it accounts for only 3 per cent of health workers. The developed countries with the lowest relative disease burden have the highest numbers of health workers, while Africa with the highest burden has a much smaller workforce.
For example, the United Kingdom, with a population of 68 million people, has over 370,000 physicians, while Nigeria, with over 211 million people, has less than 75,000 physicians, according to WHO. Despite that, the U.K. employs at least 12 Nigerian doctors every week. A 2008 report by Lancet showed that about one in 10 doctors working in the U.K. were from sub-Saharan Africa, and the figure has been increasing. For example, as of 2006, there were 2,692 Nigerian doctors in the U.K. medical workforce, and by 2018, the figure stood at 5,250.
In 2016, a former president of the Nigerian Medical Association said an estimated 8,000 Nigerian doctors were practising in the United States. A 2004 study revealed that nearly 86% of African doctors in the U.S. workforce came from only three countries, Nigeria, South Africa and Ghana, and 79 per cent of them were trained at only ten medical schools. Apart from physicians, other U.S. healthcare fields also consist of high percentages of Africans. For instance, 24% of its registered nurses, 20 per cent of nursing assistants, and 16% of personal care aides are from Africa.
Canada also has a history of increasing its health workforce with African-trained professionals. As of 2001, 17 per cent of physicians in the province of Saskatchewan bagged their first degree in South Africa. A decade later, the total number of foreign-trained doctors in Canada rose to 22 per cent, with Africa being the biggest source. Other countries, including Saudi Arabia, Australia, and the UAE, have sustained their relatively high physician-to-population ratio by employing medical graduates from African countries.
The driving force behind the mass emigration is the quest for greener pastures, as many health workers struggle to cope with the working condition at home. “I left Nigeria because I wanted to earn more money, learn new things and practise in a better environment,” a Nigerian physician working in the U.S. said in an interview. Low pay, poor infrastructure, paucity of job opportunities, and fear of a bleak future for their children are some of the core identified reasons for the mass exodus.
This perennial challenge has both medical and financial implications. Despite having just 16 per cent, Africa accounts for less than 1% of total global healthcare expenditures. And looking at it in per capita terms, the rest of the world spends ten times more on healthcare than Africa. The severe funding disparity tells hugely on both its medical personnel and facilities.
On average, a surgeon in New Jersey, United States, earns $216,000 annually, while their counterparts in Zambia earn $24,000, and Kenyan physicians make on average $6,000 per annum. There are 0.3 hospital beds per 1,000 people in Ethiopia compared to Germany with 8.0 per the same number of people. There have been various cases ofZimbabwean doctors operating with bare hands due to a lack of gloves. At the peak of the coronavirus pandemic in 2020, the Central African Republic, a country of about 5 million people, had only three ventilators. And for Nigeria to meet its medical infrastructure gap, it needs an $82 billion investment in healthcare real estate and about 386,000 beds to reach the global average of 2.7 beds per 1,000 persons.
All these ills explain why more African health professionals move in droves out of the continent. Not only do they migrate to those countries, they usually see out their active service years and retire there. Being high-value immigrants in their countries of destination, they easily acquire permanent residence, such as the Indefinite Leave to Remain in the U.K., the Employment-Based Green Card in the USA, and later acquire citizenship by naturalisation. This indicates that once they fly out, there is no hope of Africa ever benefitting from their expertise anymore.
Monetary wise, many developed economies save hundreds of thousands to millions of dollars from the brain drain while Africa bears the financial losses. A 2011 study on nine sub-Saharan African countries (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe) showed that governments spent between $21,000 to $58,7000 to subsidise a doctor’s education.
Therefore, losing thousands of trained physicians to other nations after graduation puts each of these African countries in a huge financial loss. The overall loss of return was estimated to be billions of dollars, and the United Kingdom was reported to be the highest beneficiary with $2.7 billion, followed by the United States with $846 million.
In 2010, the World Health Assembly adopted a code of practice on the international recruitment of health professionals, which recommends that wealthy countries should lend financial assistance to source countries facing a shortage of healthcare workers. That same year, the U.S., through its Medical Education Partnership Initiative (MEPI),invested $130 million to support medical schools in 12 sub-Saharan countries. While such initiatives may offer a little economic relief, they will not completely solve the ills associated with the shortage, especially as many African countries grapple with high rates of preventable disease and child maternal mortality. The continent needs its trained experts to tackle this barrage of health challenges.
Many publications have questioned the motive behind Africa’s brain drain by wealthy countries and wondered if that should be viewed as a crime. However, since the recruitment is a mutual agreement between the countries and the health workers, it may be wrong to accuse the beneficiary countries of any wrongdoings. The 2010 World Health Assembly Code also attempted to stem the flow of talent migration, but it has not really been successful, as more African health workers daily queue to join their colleagues in the developed world.
This leaves Africa with no choice but to develop its health care sector and make it attractive to its medical personnel. If provided with a world-class working environment and remuneration at home, less African-trained doctors would consider emigration. The onus is on African leaders to show the required political will to curb the brain drain. This will lessen the health challenges in the continent and improve the overall wellbeing of their citizens.
Olusegun Akinfenwa is a political correspondent for Immigration News, a news organisation affiliated with Immigration Advice Service. IAS is a leading U.K. immigration law firm that helps people migrate and settle in the U.K.